AB1304 COMPARISON OF CHARACTERISTICS OF PATIENTS WITH IDIOPATHIC GRANULOMATOSIS MASTITIS IN REMISSION AND NON-REMISSION: RESULTS FROM A TERTIARY REFERRAL CENTRE
Authors: B. Farisogullari, B. Usta, E. Ersal Deregözü, G. K. Yardimci, Ö. Cennet, K. Kösemehmetoğlu, A. Konan, U. Kalyoncu
Journal: Annals of the Rheumatic Diseases (2022)

Background Idiopathic granulomatous mastitis (IGM) is an uncommon, benign, chronic inflammatory disease of the breast of unknown etiology. Although an ideal treatment regimen is controversial in IGM, the ultimate goal is remission. Objectives To compare the clinical, radiological, laboratory and treatment features of patients in remission and non-remission, and assess predictor factors of remission. Methods The data of patients who were histopathological diagnosed with IGM between 2010 and 2020 were evaluated retrospectively. The patients were divided into 2 groups as those in complete remission and non-remission. Complete improvement in clinical and physical examination with medical and/or surgical intervention findings at 2 consecutive visits was defined as complete remission. Patients who were not in complete remission including partial remission and refractory to treatment, were defined as non-remission group. Results In this study, there were a total of 103 patients with a diagnosis of IGM followed-up in the rheumatology clinic. Of these, 39 (38%) were in remission and 64 (62%) were non-remission. Age, age at symptom onset, comorbidity, pregnancy (ever), disease localization, clinical signs and symptoms, imaging classification, and baseline acute phase reactants and autoimmune markers were similar in the remission and non-remission groups. The use of antibiotics and azathioprine was significantly higher in the remission group than in the non-remission group. However, there was no difference between the groups in terms of breast surgery, use of corticosteroids and methotrexate (Table 1). In the univariable analysis, antibiotic use [OR: 2.55 (95% CI 1.07-6.11)] was found to be a predictor factor of remission. Table 1. Characteristics of patients in remission and non-remission All patients Patients in remission Patients not in remission p value n= 103 n = 39 n= 64 Age, years 38.1 ± 7.1 39.6 ± 7.8 37.2 ± 6.5 0.07 Age at symptom onset, years 33.5 ± 6.6 34.4 ± 7.3 33 ± 6.1 0.30 Comorbidity, n (% ) Thyroid disorders 4 (3.9) 1 (2.6) 3 (4.7) 1.00 Hypertension 2 (2) 2 (5) 0 0.14 Diabetes mellitus 1 (1) 1 (2.6) 0 0.38 Pregnancy (ever), positive/total (% ) 75/77 (97.4) 31/32 (97) 44/45 (98) 1.00 Breast localization, n (% ) Left 47 (45.6) 19 (48.7) 28 (43.8) 0.88 Right 36 (35) 13 (33.3) 23 (35.9) Bilateral 20 (19.4) 7 (17.9) 13 (20.3) Clinical signs and symptoms, n (% ) Palpabl mass 94 (91.3) 35 (89.7) 59 (92.2) 0.72 Fistula formation 37 (38.1) 16 (42.1) 21 (35.6) 0.52 Erythema 61 (65.6) 23 (65.7) 38 (65.5) 0.98 Nipple inversion 11 (12) 2 (5.4) 9 (16.4) 0.19 Axillary lymph node 45 (48) 17 (47.2) 28 (48.3) 1.00 Erythema nodosum 10 (9.9) 4 (10.3) 6 (9.7) 1.00 Arthralgia 13 (12.6) 3 (7.7) 10 (15.6) 0.36 BI-RADS classification*, n (% ) 2 13 (25) 7 (35) 6 (18.8) 0.12 3 31 (59.6) 9 (45) 22 (68.8) 4 6 (11.5) 2 (10) 4 (12.5) 5 2 (3.8) 2 (10) 0 Baseline laboratory -CRP (mg/dL ) 0.75 (1.4) 0.75 (1.4) 0.73 (1.4) 0.77 - ESR (mm/h ) 23 (28) 21.5 (28) 25.5 (28) 0.39 -ANA (more than or equal 1/100), n α (% ) 37/69 (53.6) 12/25 (48) 25/44 (56.8) 0.48 -RF, n α (% ) 12/30 (40) 5 /16 (45.5) 7/19 (36.8) 0.71 -anti-CCP, n α (% ) 3/12 (25) 2/5 (40) 1/7 (14) 0.52 Treatment, n (% ) Surgical intervention 38 (36.9) 16 (41) 22 (34.4) 0.49 Antibiotics 63 (61.2) 29 (74.4) 34 (53.1) 0.03 Corticosteroids 93 (90.3) 34 (87.2) 59 (92.2) 0.49 Methotrexate 66 (64.1) 26 (66.7) 40 (62.5) 0.67 Azathioprine 19 (18.4) 11 (28.2) 8 (12.5) 0.04 * 52 patients with data were evaluated. α positive/total Results are given as mean ± SD or median (IQR). ANA: Antinuclear antibody; anti-CCP: Anti-cyclic citrullinated peptides; BI-RADS: Breast imaging-reporting and data system; RF: Rheumatoid factor Conclusion Patients with in remission did not have the distinctive baseline demographic, clinical, laboratory and radiological features that distinguish them from patients with in non-remission. Patients in remission used more antibiotics and azathioprine. Antibiotic use seems to be associated with remission in univariable analysis. However, further studies are needed to evaluate the factors associated with remission in IGM. Disclosure of Interests None declared